Pancreatic Histopath Flashcards Preview

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Flashcards in Pancreatic Histopath Deck (34):
1

Role of the pancreas

Production of 2L a day of enzymic HCO3 rich fluid, stimulated by secretin & CCK

2

Role of secretin (2) & produced by which cells

Produced by s-cells of duodenum - in response to acid chyme from stomach Stimulates HCO3- release from pancreas (centroacinar cells)

Inhibits gastric acid secretion from parietal cells

3

Role of CCK (2) & produced by which cells

Produced by I-cells of duodenum (in response to food in duodenum)

Stimulates digestion of fat & protein by causing release of digestive enzymes (from acinar cells)

Stimulates gallbladder contraction > release bile

4

Function of alpha cells, beta cells, delta cells,

alpha - glucagon beta - insulin delta - somatostatin (endocrine cyanide)

A image thumb
5

Function of D1 cells &

pancretic polypeptide cells

D1 cells - a vasoactive intestinal peptide (VIP) that stimulates secretion of H2O

PP cells - secrete PP, which stimulates secretion of gastric & intestinal enzymes, whilst reducing intestinal motility. Self regulates secretion activities

6

Criteria of metabolic syndrome (5)

Dyslipidaemia - HDL 2mmol/l

Fasting blood sugar > 6mmol/l

BP > 140/90

Central obesity > 94 cm in M, > 80 cm in F

Microalbuminaemia

7

Diagnosis of DM

fasting plasma glucose > 7 mmol/l

Random blood glucose > 11.1 mmol/l

8

Symptoms of DM (3)

Polyuria

Polydipsia

Recurrent infections

9

Macrovascular complications of diabetes (3)

Cardiac - MI

REnal - GN or pyelonephritis

Cerebral - CVA

10

Microvascular complications of diabetes (2)

Ocular - diabetic retinopathy

PVS - claudication,

poor healing ulcer

11

Causes of Acute pancreatitis (11)

I - idiopathic, G - gallstones, E - ETOH, T - trauma, S- steroids, M - mumps, A - autoimmune, S - scorpion venom, H - Hyperlipidaemia, E - ERCP, D - Drugs e.g. thiazides

12

Presentation of acute pancreatitis (3)

Severe epigastric pain - relieved by leaning forward

Vomiting Pain radiates to back

13

Histology of acute pancreatitis (1)

Coagulative necrosis

14

Complication of acute pancreatitis (1)

formation of pseudocyst

15

Ix of acute pancreatitis (1)

serum LIPASE (amylase on transiently increased)

16

Causes of chronic pancreatitis (5)

Alcoholism

Pancreatic duct obstruction e.g. stone

Autoimmune

CF

Hereditary

17

Presentation of chronic pancreatitis (3)

epigastric pain radiating to back

Malabsorption results in weight loss & steatorrhea secondary DM - due to lack of enzymes to digest food

18

Histology of chronic pancreatitis (3)

Fibrosis + loss of exocrine tissue

Duct dilatation with thick secretions

calcification

19

Acinar cell carcinoma presentation (4)

A rare cancer seen in eldery,

get enzyme secretion by neoplastic cells

Presentation - non specific weight loss, abdo pain, nause & vomiting

10% get multi-focal fat necrosis & polyarthralgia - due to lipase

20

Histolopath of acinar cell carcinoma (3)

neoplastic epithelial cells with eosinophilic granular cytoplasm positive immunoreactivity for lipase, trypsin, chymotrypsin

21

Prognosis of acinar cell carcinoma

Poor - median survival 18 months, 5 yr

22

Ductal adenocarcionma of pancreas epidemiology - age group, gender & site

85% of all pancreatic cancers

Age > 60

M> F

Head of pancreas - Causes obstruction of bile duct > jaundice 

23

Ductal adenocarcionma of pancreas risk factors (3)

Smoking

diet

Genetic e.g. HNPCC & FAP

24

Clinical features of Ductal adenocarcionma of pancreas (8)

Cachexia & anorexia

Epigastric + back pain - chronic & severe

Jaundice (PAINLESS), pruritis, steatorrhea

Ascites

Abdo mass

Virchow's node

Trousseau's syndrome (25%) - recurrent superficial thrombophlebitis

Courvoisier's sign

25

Investigations of Ductal adenocarcionma of pancreas (3)

Bloods - low Hb, high Br, high Ca2+

CT/MRI/ERCP

CA19.9 > 701 (low spec & sens - only used after diagnosis established)

26

Management of Ductal adenocarcionma of pancreas (3)

Chemo is palliative 5-FU

Surgery - Whipple's procedure

Poor prognosis - 5 yr survival

27

Where are neuroendocrine tumours usually found? (2)

Body or tail of pancreas

28

neuroendocrine tumours lie on a spectrum (benign > malignant) can be functional give examples (3)

Insulinoma - hypoglycaemic attacks

Gastrinoma - Zollinger-Ellison syndrome - recurrent ulceration due to high acid output

Glucagonoma - Necrolytic migrating erythema

VIPoma - diarrhoea

29

Non functional neuroendocrine tumours

incidental finding on imaging or when large enough to produce symptoms

30

Ix & Rx of neuroendocrine tumours

CT/ MRI

Surgery

31

MEN-1 (3)

PPP

Pancreatic endocrine tumour (often a phaeo)

Parathyroid

Pituitary adenoma

32

MEN 2A (3)

Parathyroid

Thyroid

Phaeo

33

MEN 2B (3)

Medullary thyroid

Phaeo

Neuroma MARFINOID PHENOTYPE

34

Pancreatic malformations (3)

Ectopic pancreas - esp stomach/ small intestine

Pancreas divisum - failure of fusion of dorsal + ventral buds; increased risk of pancreatitis

Annular pancreas - can present with duodenal obstruction (1 yr)